COMSAE Phase 2 Practice Questions: High-
Yield Clinical Scenarios with Answers and
Rationales
Section 1: Cardiovascular & Pulmonology (Questions 1-20)
Question 1
,A 62-year-old man with long-standing hypertension presents with progressive exertional dyspnea and
bilateral lower-extremity edema. Echocardiogram shows concentric left ventricular hypertrophy with
preserved ejection fraction. What is the most likely diagnosis?
A. Dilated cardiomyopathy
B. Restrictive cardiomyopathy
C. Heart failure with preserved ejection fraction
D. Acute systolic heart failure
Correct Answer: C
Rationale: HFpEF is classic in older patients with chronic hypertension. Concentric LV hypertrophy causes
diastolic dysfunction while EF remains normal. Dilated cardiomyopathy would show reduced EF and
chamber dilation. COMSAE frequently tests this distinction in hypertensive patients with dyspnea and
edema .
,Question 2
A patient with atrial fibrillation develops sudden onset left arm weakness and slurred speech. What is the
best initial imaging study?
A. MRI brain with contrast
B. CT head without contrast
C. Carotid Doppler
D. CT angiography
Correct Answer: B
Rationale: Non-contrast CT head is ALWAYS first in suspected stroke to rule out hemorrhage before
considering thrombolytics. This sequencing is heavily tested on NBOME examinations .
, Question 3
A 67-year-old man develops crushing substernal chest pain radiating to his left arm. ECG shows ST-
segment elevations in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Correct Answer: C
Rationale: ST elevations in leads II, III, and aVF indicate an inferior wall myocardial infarction. The right
coronary artery supplies the inferior wall in most individuals. Prompt recognition guides reperfusion therapy
and risk assessment for complications such as AV block .
Yield Clinical Scenarios with Answers and
Rationales
Section 1: Cardiovascular & Pulmonology (Questions 1-20)
Question 1
,A 62-year-old man with long-standing hypertension presents with progressive exertional dyspnea and
bilateral lower-extremity edema. Echocardiogram shows concentric left ventricular hypertrophy with
preserved ejection fraction. What is the most likely diagnosis?
A. Dilated cardiomyopathy
B. Restrictive cardiomyopathy
C. Heart failure with preserved ejection fraction
D. Acute systolic heart failure
Correct Answer: C
Rationale: HFpEF is classic in older patients with chronic hypertension. Concentric LV hypertrophy causes
diastolic dysfunction while EF remains normal. Dilated cardiomyopathy would show reduced EF and
chamber dilation. COMSAE frequently tests this distinction in hypertensive patients with dyspnea and
edema .
,Question 2
A patient with atrial fibrillation develops sudden onset left arm weakness and slurred speech. What is the
best initial imaging study?
A. MRI brain with contrast
B. CT head without contrast
C. Carotid Doppler
D. CT angiography
Correct Answer: B
Rationale: Non-contrast CT head is ALWAYS first in suspected stroke to rule out hemorrhage before
considering thrombolytics. This sequencing is heavily tested on NBOME examinations .
, Question 3
A 67-year-old man develops crushing substernal chest pain radiating to his left arm. ECG shows ST-
segment elevations in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Correct Answer: C
Rationale: ST elevations in leads II, III, and aVF indicate an inferior wall myocardial infarction. The right
coronary artery supplies the inferior wall in most individuals. Prompt recognition guides reperfusion therapy
and risk assessment for complications such as AV block .
